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Background: The clinical manifestations of sepsis are highly variable. The signs of both infection and organ dysfunction may be subtle, and thus the most recent international consensus guidelines provide a long list of warning signs of incipient sepsis. Lactic acid, which is a by-product of anaerobic metabolism, can be used as a marker of tissue hypoperfusion. It is being used widely. Procalcitonin has more recently been studied in children.Methods: Totally 60 Children admitted with Septic Shock in PICU between Ages 3 Months to 12 Years were assessed for Serum Lactate & Serum Procalcitonin levels. Evaluation of the biomarkers was done on individual and combinational basis using receiver operating characteristics curve.Results: Out of 60 children, male were 40, female were 20 children. In stage-1 serum lactate' level was 47.83 (mg/dl) sensitivity is about 35.63 and specificity was 63.82' off p-value <0.065**.In stage -2 serum procalcitonin was 49.62 (mg/dl) sensitivity is about 37.77 and specificity was 69.28' off p-value <0.549**.In stage -3 serum procalcitonin was 52.89 (mg/dl) sensitivity is about 41.63 and specificity was 73.89' off p-value <0.651**Conclusions: Early recognition of risk factors will help in timely appropriate therapy and thereby will help in reducing mortality and morbidity in pediatric septic shock. The results suggest that PCT is valid for auxiliary diagnosis of septic conditions in children and used as an indicator of the severity of patients.
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Objective To explore the risk factors of systemic inflammatory response syndrome crisis (SIRS) after percutaneous nephrolithotomy (PCNL) in China. Methods Databases of CNKI, CBM, WanFan and VIP were searched to retrieve studies about systemic inflammatory response syndrome after percutaneous nephrolithotomy to October, 2016. Results 18 studies involving 5,323 patients were included. The results of meta-analysis showed that:a) univariate analysis indicated that renal insufficiency [O(R) =2.78, 95%CI (1.96 to 3.95), P = 0.000], preoperative positive urine culture [O(R) = 3.41, 95%CI (1.89 to 6.15), P = 0.000], preoperative routine urine leucocyte positive [O(R) = 3.78, 95%CI (3.02 to 4.72), P = 0.000], diabetes mellitus [O(R) = 2.14, 95%CI (1.33 to 3.45), P = 0.002], pelvic positive urine culture [O(R)= 5.14, 95%CI (2.46 to 10.73), P = 0.000] and operation time ≥120 min [O(R) = 2.31, 95%CI (1.40 to 3.82), P = 0.001] were the risk factors of SIRS; b) multivariate analysis showed that, preoperative positive urine culture [O(R) = 6.83, 95%CI (2.82 to 16.57), P = 0.000], preoperative routine urine leucocyte positive [O(R) = 5.43, 95%CI (3.51 to 8.41), P = 0.000], diabetes mellitus [O(R) = 2.85, 95%CI (1.45 to 5.58), P = 0.002], pelvic positive urine culture [O(R) = 4.30, 95%CI (1.30 to 14.21), P = 0.020] and operation time ≥120 min [O(R) = 2.72, 95%CI (1.62 to 4.59), P = 0.000] were the independent risk factors of MCAT. Conclusion The independent risk factors of SIRS for patients after PCNL are diabetes mellitus, preoperative positive urine culture, preoperative routine urine leucocyte positive, pelvic positive urine culture and operation time. However, due to the quantity and low quality of the included literature, the conclusion needs the support from high quality studies.
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Objective To explore the risk factors of systemic inflammatory response syndrome crisis (SIRS) after percutaneous nephrolithotomy (PCNL) in China. Methods Databases of CNKI, CBM, WanFan and VIP were searched to retrieve studies about systemic inflammatory response syndrome after percutaneous nephrolithotomy to October, 2016. Results 18 studies involving 5,323 patients were included. The results of meta-analysis showed that:a) univariate analysis indicated that renal insufficiency [O(R) =2.78, 95%CI (1.96 to 3.95), P = 0.000], preoperative positive urine culture [O(R) = 3.41, 95%CI (1.89 to 6.15), P = 0.000], preoperative routine urine leucocyte positive [O(R) = 3.78, 95%CI (3.02 to 4.72), P = 0.000], diabetes mellitus [O(R) = 2.14, 95%CI (1.33 to 3.45), P = 0.002], pelvic positive urine culture [O(R)= 5.14, 95%CI (2.46 to 10.73), P = 0.000] and operation time ≥120 min [O(R) = 2.31, 95%CI (1.40 to 3.82), P = 0.001] were the risk factors of SIRS; b) multivariate analysis showed that, preoperative positive urine culture [O(R) = 6.83, 95%CI (2.82 to 16.57), P = 0.000], preoperative routine urine leucocyte positive [O(R) = 5.43, 95%CI (3.51 to 8.41), P = 0.000], diabetes mellitus [O(R) = 2.85, 95%CI (1.45 to 5.58), P = 0.002], pelvic positive urine culture [O(R) = 4.30, 95%CI (1.30 to 14.21), P = 0.020] and operation time ≥120 min [O(R) = 2.72, 95%CI (1.62 to 4.59), P = 0.000] were the independent risk factors of MCAT. Conclusion The independent risk factors of SIRS for patients after PCNL are diabetes mellitus, preoperative positive urine culture, preoperative routine urine leucocyte positive, pelvic positive urine culture and operation time. However, due to the quantity and low quality of the included literature, the conclusion needs the support from high quality studies.
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Aims: The aim of this research was to investigate the genetically determined predisposition to develop SIRS and sepsis by analyzing human leukocyte antigen HLA class II genes. Study Design: children defined by the criteria for SIRS of Critical Care Medicine Consensus Conference were included into the study in a prospective manner. Place and Duration of Study: Riga Stradiņš University Laboratory of Clinical Immunology and Immunogenetic, Department of Pediatrics, Rīga Stradiņš University, and Children’s Clinical University Hospital, Latvia, between January 2008 and May 2009. Methodology: Samples from children with SIRS and sepsis were collected at the Children`s Clinical University Hospital of Latvia. During the study, 65 patients with SIRS were observed. In 12 cases among SIRS patients, sepsis was confirmed. DNA was separated from lymphocytes of peripheral blood. At the same time, 100 DNA samples from healthy children were analysed. HLA typing low-resolution for HLA- DRB1; DQB1; DQA1 was performed by polymerase chain reaction (PCR) with amplification with sequence-specific primers (SSP). PCR products were separated on 3% arose, the amplified bands were visualised. The frequency of alleles and genotypes were compared between the patients and the controls using chi-square test. P-value and odds ratio were calculated using EPI INFO software version 6 with 95 % confidence intervals and Fisher exact correction for small numbers. Results: The frequency of DRB1*07:01 allele was significantly increased in patients with SIRS (OR=8.71; 95% Cl = 2.8-26.8; p<0.0001) and patients with sepsis (OR=9 .70; 95% Cl = 2.3-42.2; p<0.005). In-group SIRS was significantly increased DQB1*03:02 (OR=2.19; 95% Cl = 1.1-4.8; p<0.049) and sepsis group DQB1*03:01 (OR=2.95; 95% Cl = 1.3-7.1; p<0.013) alleles also. But the frequency of DRB1*15:01 (OR=0.50; ; 95% Cl = 0.2-0.9; p<0.038) and DQB1*06:01, (OR=0.16; 95% Cl = 0.2-1.3; p<0.042) alleles was lower in all SIRS patients than in control group. In the distribution of HLA DRB1*/DQA1*/DQB1*, such haplotypes as DRB1*07:01/DQA1*02:01/DQB1*03:02, (OR=8.08; 95% Cl = 0.9-74.2; p<0.049); DRB1*07:01/DQA1*02:01/DQB1*05:01, (OR=8.08; 95% Cl = 0.9-74.2; p<0.049) and DRB1*04:01/DQA1*03:01/DQB1*02:01-2 (OR=5.10; 95% Cl = 0.9-27.3; p<0.049) in SIRS group were frequently detected. The haplotypes DRB1*07:01/DQA1*02:01/DQB1*03:01, (OR=33; 95% Cl = 0.9-27.3; p<0.004); DRB1*07:01/DQA1*03:01/DQB1*03:01; (OR=19.80; 95% Cl = 0.9-27.3; p<0.029) and DRB1*04:01/DQA1*02:01/DQB1*03:01, (OR=19.80; 95% Cl = 0.9-27.3; p<0.03) were frequently found in septic group patients. Conclusion: Our pilot data shows that the susceptibility markers HLA-DRB1*07:01/ DQA1*02:01/ DQB1*03:01, in sepsis patients are partly consistent with literature data. The number of patients in the study is relatively small. In order to increase statistical significance of results and to prove current findings, it is important to continue the study.
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ObjectiveTo explore the therapeutic effect of continuous veno-venous hemofiltration (CVVH) on the treatment of severe acute pancreatitis (SAP).MethodsAll data about forty-five patients with SAP admitted to the intensive care unit (ICU) from June 2005 through June 2010 were reviewed.These 45 patients were randomly (random number ) divided into routine treatment group (n =22 )and comprehensive treatment group ( n =23 ).In control group,patients were rapidly given with a suffficient liquid support,vasoactive drug to increase organ perfusion,trypsin secretion inhibitor,broad-spectrum antibiotics,enteral nutrition with intestine membrane protective agent in early stage.In the comprehensive treatment group,patients received CVVH integrated with routine treatment.On admission and 72 h posttreatment,the scores of acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) and multiple organ dysfunction syndrome (MODS),and the results of standard bettery of biochemistry tests indcluding blood urea nitrogen (BUN),serum cratinine (Scr),total bilirubin (TBIL),alanine aminotransferase (ALT),amylase (AMS),C-reactive protein (CRP),TNF-α,IL-6,IL-8 were observed.Time of mechanical ventilation support,length of ICU stay,and survival rate were compared between two groups.ResultsOn admission between the two groups,no statistical significance was seen in the APACHE Ⅱ and MODS score,BUN,Scr,TBIL,ALT,AMS,CRP,TNF-α,IL-6,IL-8 (P ＞ 0.05).But APACHE Ⅱ and MODS score were decreased significantly in comprehensive treatment group than in the routine treatment group,as well as the the level of BUN,Scr,TBIL,ALT,AMS,TNF-α,IL-6,IL-8 and CRP after 72h post-treatment (P＜0.05 ).In routine treatment group and comprehensive treatment group,the time of respirator intervention and length of stay in ICU were (7.6±3.4) d vs.(11.5±4.7) d,(12.3±7.8) dvs.(17.6±9.2) d respectively,the statistical significance was shown ( P ＜ 0.05 ).Compared to the comprehensive treatment group ( 86.96％ ),the survival rate ( 59.09％ ) were lower in routine treatment group ( P ＜ 0.05 ).ConclusionsCVVH combined with routine treatment,which can remove inflammatory agents and toxins,maintain homoeostasis,and improve oxygenation,is effective in treatment of SAP and can improve patient survival rate.
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Objective By means of animal study,investigated the gut barrier function in severe acute pancreatitis ( SAP),and role of inflammatory factors releasing,gut mucosa oxidative stress,cell apoptosis in it.Methods The animal experiment was done in the animal center of first people' s hospital,shanghai jiaotong university.Twenty four BALB/c mice were randomized ( random number) divided into two groups with twelve mice each group.The SAP group,mice received six intraperitoneal injections of cerulein at 1-hour intervals, the dose was 50μg/kg, then given one intraperitoneal injection of 10 mg/kg lipopolysaccharide ( LPS from E.Coli) for the induction of severe acute pancreatitis.The control ( sham operation) group,the mice received intraperitoneal injection of 2 ml normal saline for six times at 1-hour intervals.All the animals of each group were averaged to two batches,4 h and 8h after being operated respectively,to be anesthetized and adopted blood and tissue specimen.Then we observed the pathological change of pancreas and gut,scored it.We measured the blood value of diamine oxidase ( DAO),amylase and tumor necrosis factor-α (TNF-α).We detected content of malondialdehyde (MDA),superoxide dismutase (SOD),glutathione (GSH) and activity of xanthine oxidase (XO) in gut mucosa.We detected the casepase-3 activity and cell apopotosis by means of terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) in gut mucosa,and conculated the apopotosis index (AI).Then using the PASW 18.0 software,we analyzed the data by anova and t-test,to make sure if the values were statistically different between the two groups and the mechanism of gut barrier dysfunction in panreatitis.Results At 4 h and 8 h after operation,the SAP-group-mice had significantly higher pancreas pathological score (P ＜0.01 ),blood amylase value ( P ＜ 0.05 ),gut pathological score and blood DAO and TNF-α value ( P ＜0.01 ),compared with the contral-group-mice.The gut mucosa MDA content and XO activity of mice in SAP group were significantly higher than which in control group ( P ＜ 0.01 ). The SAP-group-mice had significantly lower gut mucosa SOD content ( P ＜ 0.01 ) and GSH content ( P ＜ 0.05 ),compared with the contral-group-mice.The gut mucosa cells of mice in SAP group had significantly higher caspase-3 activity and apoptosis index than which in control group ( P ＜ 0.01 ).Conclusions In severe acute pancreatitis,inflammatory factors such as TNF-αwere waterfall-style released,induced gut mucosa suffer from ischemia-reperfusion injury,then serious oxidative stress developed in mucosa and activated caspase-3 pathway,inducing gut mucosa cells apoptose seriously,which was an important mechanism of gut barrier dysfunction.
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ObjectiveTo explore the changes of systemic inflammatory response syndrome (SIRS)after cardiopulmonary resuscitation to provide basis for clinical prevention and treatment. MethodsForty rabbits were divided into the sham-operated group; the cardiac arrest for 4 minutes, 5 minutes and 6 minutes groups randomly (random number). Then the rabbits were anaesthetized, retrograde tracheal intubated .The cardiac arrest were induced by aphysia to all rabbits except the sham-operated group and the cardiopulmonary resuscitation were performed after 4, 5 and 6 minutes. The physiological parameters were evaluated at 24, 48, 72, 96 and 120 h after cardiac arrest. The serum samples were taken at the same to detect the level of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and white blood cell.The data were analysed by repeated measure variance. ResultsThe SIRS were presented at all cardiopulmonary resuscitation groups after 24 h of cardiac arrest. Compared to the sham-operated group, the level of TNF-α and CRP in resuscitation groups was significantly increased ( P ＜ 0. 01 ). To the group arrested for 4 minutes, the SIRS were higher at 24 ～ 48 h and dissipated at 72 h. To the groups arrested for 5 or 6minutes, SIRS were lasted for 96 h. ConclusionsSIRS is easy to recover if resuscitation was taken within 4 minutes after cardiac arrest. After 5 minutes, SIRS is severe and hard to recover. Serum TNF-α is a sensitive marker to evaluate SIRS and can be used as the supplymentary diagnosic marker of SIRS to providing early treament and prevention.
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Despite the development of modern intensive care and new antimicrobial agents, the mortality of the patients with severe sepsis and septic shock remains high. The poor outcome is considered to be a consequence of an overactive systemic inflammatory response. Sepsis is now defined as systemic inflammatory response syndrome (SIRS) in which there is an identifiable focus of infection. As a consequence of the overactive SIRS response, the function of various organ systems may be compromised, resulting in multiple organ dysfunction syndrome (MODS) and death. Systemic inflammation is a consequence of activation of the innate immune system. It is characterized by intravascular release of pro-inflammatory cytokines and other vasoactive mediators, and the concurrent activation of the innate immune cells. In addition to the pro-inflammatory reactions, the host's anti-inflammatory mechanisms are also activated and aimed at counteracting the inflammatory response. The balance between pro- and anti-inflammatory reactions is critical for the outcome of the patient. Understanding the mechanisms of acute inflammatory responses in critical ill patients is necessary for the development of urgently needed therapeutics. The aim of this review is to provide a description of the key components and mechanisms involved in the inflammatory response in patients with SIRS and sepsis.
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Humanos , Antiinfecciosos , Citocinas , Sistema Inmunológico , Inflamación , Cuidados Críticos , Insuficiencia Multiorgánica , Sepsis , Choque Séptico , Síndrome de Respuesta Inflamatoria SistémicaRESUMEN
cs the pathological process of ARDS.
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Objective To study the effects of small dosage insulin on intestinal inflammatory responses to endotoxin rats. Method Thirty two male SD rats were randomly divided into 4 groups (n = 8): control group, endotoxin (LPS,6 mg/kg i.p.)group, regular insulin(RI,0.5 IU/kg hypodermic) group and LPS(6 mg/kg i.p) + RI (0.5 IU/kg hypodermic)group. Six hours after LPS or saline injection,all rats were laparotomized to observe the congestion in intestinal mucosa with naked-eyes and photography.Then a segment of intestine was stained with HE to observe the pathological changes. The expressions of IL-6 and TNF-α were detected by RT-PCR.The systemic inflammatory response,blood sugar and food taken in rats were observed simultaneously. Software SPSS 13.0 was used to perform ANOVA and Chi-square test for statistical analysis. Results Compared with LPS group, the differences in hyperemia and inflammatory cell infiltration in intestinal tissue were not noticeable in LPS + RI group. The expression of IL-6 and TNF-α were significantly attenuated in RI + LPS group (P < 0.01). All rats in LPS group manifested systemic inflammatory response syndrome (SIRS) four or five hours after LPS treatment, while there was none in LPS + RI group. Rats in LPS group took less food than rats of other groups while the blood sugar had litter difference in all groups (P > 0.05). Conclusions Small dosage of insulin could reduce intestinal inflammation caused by endotoxemia. Early administration of insulin ould prevent the presence of SIRS while it has no obvious influence on blood sugar.
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Un estudio observacional fue realizado durante 9 meses en el Hospital Materno Infantil 10 de Octubre, en Ciudad de La Habana, donde se incluyeron todos los pacientes que fueron ingresados en el Servicio de Neonatología en ese período. El objetivo de este estudio fue determinar el comportamiento del Síndrome de Respuesta Inflamatoria Sistémica (SIRS) en recién nacidos y evaluar los principales factores perinatales que se relacionaron con la mortalidad. La definición del SIRS fue modificada y también definimos el Síndrome de Disfunción Múltiple de Organos (MODS). Todos los pacientes fueron evaluados entre 24- 48 horas después de haber sido ingresados. Fueron clasificados 47 niños de 351 como SIRS (13,4%), así como 40 de 351 como MODS (11,4%). Mientras más órganos fueron afectados, la mortalidad fue más alta. Solamente 12 niños fallecieron, 10 de ellos con MODS (83,3%). Concluimos que aunque el SIRS y el MODS son difíciles de diagnosticar en el periodo neonatal, cuando los hallazgos clínicos de ambos síndromes estuvieron presentes, los pacientes tuvieron mayor mortalidad.
An observational study was made in "10 de October", Infant-Maternity Hospital, in Havana City. All patients admit ted in the Neonatology Service during 9 months were enrolled. The objective of this study was to determine the systemic inflammatory response syndrome (SIRS) in newborns and to evaluate perinatal factors in the mortality. The SIRS definition was modified as well as the multiple dysfunction syndrome (MODS). All patients were evaluated between 24-48 hours right after their admission, 47 babies out of 351 (13,4 %) were classified as SIRS, while 40 out of 351 (11,4 %) as MODS, the more organs affected, the higher the mortality rate was. We arrived to the conclusion that although SIRS and MODS were difficult to diagnose in this kind of patients, clinical findings showed that the mortality rate increased when both syndromes are present.
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Un estudio retrospectivo fue realizado en el Hospital William Soler en la Ciudad de La Habana durante 2 años. El objetivo fue evaluar el comportamiento del síndrome de disfunción múltiple de órganos (MODS) en neonatos tratados quirurgicamente.. Se seleccionaron 130 recién nacidos que requirieron intervención quirúrgica. Se definió el síndrome de respuesta inflamatoria sistémica (SIRS) y el MODS. Los pacientes fueron evaluados entre 24-48 horas del postoperatorio. La mayor mortalidad fue en aquellos niños diagnosticados con SIRS y MODS. Una baja proporción de niños, sólo 24 de 130 (18,5 %) se clasificaron como SIRS y 27 de 130 pacientes como MODS para 20,8 %. Fallecieron 16 pacientes de 130, lo que representó 12,3 %; pero 6 de ellos no tuvieron ni SIRS ni MODS, estos casos fallecieron tardíamente debido a síndrome de intestino corto, malnutrición y sepsis. Pudimos llegar a la conclusión de que cuando los niños presentaron SIRS o MODS en las primeras 48 horas del postoperatorio, la mortalidad fue más alta que cuando estas condiciones no estuvieron presentes.
A retrospective study was carried out in William Soler Hospital, in Havana City, during 2 years. Our main goal in doing this type of study was to evaluate the multiple organ dysfunction syndrome (MODS) in surgical newborns.This study involved 130 newborns who needed to undergo surgical procedures. We modified the definition of systemic inflammatory response syndrome (SIRS) and defined MODS as well. Patients were evaluated between 24-48 hours postoperative. A low proportion of infants, 24 out of 130 (18,5 %) were classified as SIRS, and 27 out of 130 (20,8 %) as MODS, only 16 patients died long after they were operated on due to other causes such as: short bowel syndrome, malnutrition and sepsis. We could finally conclude that Mortality rate increased a lot more when babies had suffered from SIRS and MODS rather than when these conditions were not present.
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Objective:To evaluate the effect of ketamine on the expression level of hepatic stress protein IFIT1 and JAB1 during the early stage of burns in mice, and observe the location of IFIT1 and JAB1 in hepatic cells. Methods:15 C57/129 male mice were divided randomly into three groups(n=5): normal control,burns,burns+ketamine. Burns group and burns+ketamine group were inflicted with 15%~20% TBSA full thickness burn injury,and burns+ketamine group received an intramuscular injection of 10 mg/kg ketamine 15 min after burns. At 4 h after burns,hepatic tissue was taken from mice,and the levels of hepatic I- FIT1 and JAB1 were detected by western blot. Normal control hepatic pathological section was taken; then cell location of I- FIT1 and JAB1 was detected by immunohistochemistry. Results:In burns group, the expression level of hepatic IFIT1 signifi- cantly increased,while that of JAB1 decreased as compared with normal control(P
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Objective To study the autonomic nervous regulation function,and to study relationship between heart rate variability and severity,organ dysfunction and prognosis in patients with systemic inflammatory response syndrome (SIRS).Methods All the patients were divided into two groups:SIRS and non-SIRS according to the criteria of SIRS. The SIRS group included 100 patients and the non-SIRS group 30 patients,and the control group included 30 heathy adults. SIRS group was further divided into two subgroups:survivor and succumbed.Heart rate variability(HRV)was analyzed with the two methods of time-domain and frequency-domain.Results The SIRS group had significantly higher APACHEll scores and MODS scores(P＜0.01)and lower HRV when compared with the non-SIRS group(P＜0.05).In the SIRS group,the succumbed groupallad statistically higher APACHEII and MODS scores and lower HRV than the survivor group( P＜0.01).There was a negative correlation between the prognosis of the patients and SDNN(r=-4.68,P＜0.01), SDNN＜55 ms was the most sensitive(76.2%),and specific(76.7%),with positive predictive value(90.4%)and negative predictive value(52.6%).Conlusion The SIRS patients had lower HRV,and there was a negative correlations with the severity of disease,organ dysfunction and prognosis.HRV(SDNN)were the useful index to evaluate the prognosis of critically ill patients.